Open Access Publications

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Open access publications by faculty, postdocs, and graduate students in the Department of Behavioral Health and Nutrition.

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Prevalence and correlates of disordered eating at a large state university before and after the onset of the COVID-19 pandemic
(Journal of Eating Disorders, 2024-10-01) Pacanowski, Carly R.; Skubisz, Christine; Borton, David; Ryding, Rachel
Background Emerging adulthood is a transitory period in which disordered eating (DE) manifests; collecting data on the prevalence of DE among this population as well as demographic and behavioral correlates are important public health goals. Methods Data from an annual survey of undergraduate students at a large state university from 2019 to 2022 were analyzed, allowing researchers to compare prevalence and correlates before and after the onset of the COVID-19 pandemic using two brief screeners: the SCOFF and Eating Disorder Screener for Primary Care (ESP). We hypothesized that rates of DE would be greater after the onset of COVID-19 as compared to before. We also hypothesized that those identifying as women, reporting higher alcohol or drug use, and contemplating suicide would have greater odds of reporting symptoms consistent with DE. Results DE was significantly lower in pre-pandemic years compared to pandemic years: ESP pre = 38.01%(n = 704), pandemic = 48.79%(n = 645), p < 0.001; SCOFF pre = 22.82%(n = 422), pandemic = 31.46%(n = 414), p < 0.001. Logistic regressions showed women and students who contemplated suicide reported significantly greater DE, regardless of screener or time period. Inconsistent relationships were found between DE and current substance use. Conclusion These findings may inform targeted interventions for those most vulnerable to disordered eating. Plain English Summary It is important to track the rates of disordered eating (DE) in vulnerable populations like emerging adults (those who are between the ages of 18 and 25). Many emerging adults attend college, and during this time DE may occur. The COVID-19 pandemic has led to situations, like being isolated from friends and family, that we assume could increase DE. To present data on the rates of DE before and after the start of COVID-19, researchers collected data on whether college students engaged in DE two years before the start of COVID-19 (2019, 2020) and two after COVID-19 (2021, 2022). They considered whether characteristics of the student, like whether they were a man or woman or their race, were related to DE. DE increased significantly after COVID-19. Using one questionnaire, DE was about 38% before COVID-19 and increased to nearly 50% after COVID-19. Across all four years, women and students who thought about suicide were more likely to report DE. It is important to direct resources to students who are experiencing DE – which we now know could be as many as 50%. DE contributes to health problems and can worsen over time, leading to a life-threatening eating disorder.
Improving Teacher Health and Well-Being: Mixed Methods Outcomes Evaluation of the Be Well Care Well Program
(Early Childhood Education Journal, 2024-08-09) Moreland, Angela; Schnake, Kerrie; Lessard, Laura; Davies, Faraday; Prowell, Katelyn; Hubel, Grace S.
Early Care and Education (ECE) providers earn low wages, have limited access to employer sponsored health insurance, and are at higher risk for poor health (Lessard, 2020). Evidence shows that poor ECE teacher physical and mental health is associated with decreased ability to provide quality care for young children (Esquivel et al., 2016). One potential way to improve ECE teacher health is through workplace wellness interventions. Through longitudinal surveys and qualitative interviews with ECE providers, we found that, over the course of a year, ECE providers who participated in Be Well Care Well (BWCW), a 12-month wellness program designed specifically for ECEproviders, improved significantly on measures of personal strength and resilience, worker stress, job satisfaction, motivation towards health, and engagement in physical activity, which was supported by interviews conducted by a subset of teachers. Providers’ physical activity was specifically associated with the amount of time they reported engaging in components of the BWCW intervention. Compelling data was also gathered about the experience of children in the care of ECE providers who participated in BWCW. Findings show that after participating in BWCW, teachers’ interactions with the children in their care proactively facilitate healthy social and emotional development. This provides initial evidence that BWCW is a promising approach for improving the lives of ECE providers and the quality of care they provide to young children.
Comprehensive analysis of a peripheral blood transcriptome signature in piglets infected with Salmonella Typhimurium: insight into immune responses
(Applied Biological Chemistry, 2024-08-19) Bok, Eun-Yeong; Yi, Seung-Won; Lee, Han Gyu; Kim, Jae Kyeom; Lee, Kangwook; Ha, Seungmin; Kim, Bumseok; Jung, Young-Hun; Oh, Sang-Ik
Salmonella Typhimurium (ST) infection in pigs poses a significant threat to animal health and food safety; the intricate mechanisms underlying host–immune responses and pathogen persistence remain poorly understood. To address this knowledge gap, we comprehensively analyzed the peripheral blood transcriptome in piglets infected with ST. We performed histopathological evaluation, blood parameter analysis, advanced RNA-sequencing techniques, and quantitative reverse transcription PCR (RT-qPCR)-based validation. The increasement in the monocyte counts at 2 days post-infection suggested its potential to serve as a hematological marker for ST infection in piglets. Functional and pathway enrichment analyses of the differentially expressed genes highlighted the pivotal roles of innate and adaptive immune responses, notably in pathways associated with Toll-like receptors, NIK/NF-κB signaling, cytokine signaling, and T cell proliferation. RT-qPCR-based validation using peripheral blood mononuclear cells provided additional insights into the immune system dynamics in response to ST infection, revealing the marked elevation of the interleukin (IL)-15, IL-27, and CXCL10 levels being significantly elevated in ST-infected piglets. Our comprehensive analysis underscores the multifaceted impact of ST infection on piglets and offers valuable insights into the host–pathogen interactions and the role of host immune system during ST infection.
The effectiveness of a neck strengthening program using the NecksLevel ® device in a population of youth female soccer players
(International Journal of Physical Education, Sports and Health, 2024-06-28) O’Reilly, Erin; Delaney, Amanda; Schneider, Jeffrey; Ruggiero, Laurie
Research has shown that neck strengthening exercises can improve neck strength with a direct translation to a reduction in head acceleration during headers. The purpose of this research was to evaluate the use of a novel neck strengthening program on neck strength and girth in a population of youth female soccer players. Using a contemporary neck strengthening device we examined outcomes in isometric neck strength and neck girth in a cohort of 16 female youth (aged 12) soccer players. Paired samples T-tests were conducted to determine differences between pre-and post-training measures. Right Lateral Bending neck strength improved significantly pre- (16.4±5.0 lb.) to post- (17.1±4.4 lb.) training. Flexion, Extension, and Left Lateral Bending neck strength were also improved. These findings underscore the effectiveness of targeted neck-strengthening exercises in enhancing neck strength among female youth soccer athletes and highlight the importance of comprehensive strategies in concussion prevention.
Associations between Brain Alpha-Tocopherol Stereoisomer Profile and Hallmarks of Brain Aging in Centenarians
(Antioxidants, 2024-08-17) Chan, Jia Pei; Tanprasertsuk, Jirayu; Johnson, Elizabeth J.; Dey, Priyankar; Bruno, Richard S.; Johnson, Mary Ann; Poon, Leonard W.; Davey, Adam; Woodard, John L.; Kuchan, Matthew J.
Brain alpha-tocopherol (αT) concentration was previously reported to be inversely associated with neurofibrillary tangle (NFT) counts in specific brain structures from centenarians. However, the contribution of natural or synthetic αT stereoisomers to this relationship is unknown. In this study, αT stereoisomers were quantified in the temporal cortex (TC) of 47 centenarians in the Georgia Centenarian Study (age: 102.2 ± 2.5 years, BMI: 22.1 ± 3.9 kg/m2) and then correlated with amyloid plaques (diffuse and neuritic plaques; DPs, NPs) and NFTs in seven brain regions. The natural stereoisomer, RRR-αT, was the primary stereoisomer in all subjects, accounting for >50% of total αT in all but five subjects. %RRR was inversely correlated with DPs in the frontal cortex (FC) (ρ = −0.35, p = 0.032) and TC (ρ = −0.34, p = 0.038). %RSS (a synthetic αT stereoisomer) was positively correlated with DPs in the TC (ρ = 0.39, p = 0.017) and with NFTs in the FC (ρ = 0.37, p = 0.024), TC (ρ = 0.42, p = 0.009), and amygdala (ρ = 0.43, p = 0.008) after controlling for covariates. Neither RRR- nor RSS-αT were associated with premortem global cognition. Even with the narrow and normal range of BMIs, BMI was correlated with %RRR-αT (ρ = 0.34, p = 0.021) and %RSS-αT (ρ = −0.45, p = 0.002). These results providing the first characterization of TC αT stereoisomer profiles in centenarians suggest that DP and NFT counts, but not premortem global cognition, are influenced by the brain accumulation of specific αT stereoisomers. Further study is needed to confirm these findings and to determine the potential role of BMI in mediating this relationship.
Device-estimated sleep metrics do not mediate the relation between race and blood pressure dipping in young black and white women
(Journal of Clinical Hypertension, 2024-07-09) D'agata, Michele N.; Hoopes, Elissa K.; Keiser. Thomas; Patterson, Freda; Szymanski, Krista M.; Matias, Alexs A.; Brewer, Benjamin C.; Witman, Melissa A.
Short, disturbed, and irregular sleep may contribute to blunted nocturnal blood pressure (BP) dipping, a predictor of cardiovascular disease. Black women (BLW) demonstrate less BP dipping and poorer sleep health than White women (WHW). However, it remains unclear whether device-estimated sleep health metrics mediate the relation between race and BP dipping in young women. We hypothesized that the relation between race and BP dipping would be partly mediated by sleep health metrics of sleep duration, sleep efficiency, and sleep regularity. Participants (20 BLW, 17 WHW) were 18–29 years old, normotensive, nonobese, and without evidence of sleep disorders. Systolic and diastolic BP dipping were derived from 24-h ambulatory BP monitoring. Habitual sleep duration and sleep efficiency were estimated via 14 days of wrist actigraphy. Sleep duration regularity was calculated as the standard deviation (SD) of nightly sleep duration (SDSD). Sleep timing regularity metrics were calculated as the SD of sleep onset and sleep midpoint (SMSD). Mediation analysis tested the mediating effect of each sleep metric on the relation between race and BP dipping. BLW experienced less systolic (P = .02) and diastolic (P = .01) BP dipping. Sleep duration (P = .14) was not different between groups. BLW had lower sleep efficiency (P < .01) and higher SDSD (P = .02), sleep onset SD (P < .01) and SMSD (P = .01). No sleep metrics mediated the relation between race and BP dipping (all indirect effects P > .38). In conclusion, mediation pathways of sleep health metrics do not explain racial differences in nocturnal BP dipping between young BLW and WHW.
Associations between anthropometry, body composition, and body image in athletes: a systematic review
(Frontiers in Psychology, 2024-05-13) Webb, Mary D.; Melough, Melissa M.; Earthman, Carrie P.; Katz, Sarah E.; Pacanowski, Carly R.
Introduction: Poor body image is a potent risk factor for disordered eating and eating disorders. Athletes are a population at increased risk for eating disorders despite reports of lower body image concerns compared to non-athletes. Body size and composition may influence an athlete’s susceptibility to poor body image. Methods: Five electronic databases (PubMed, Cochrane Library, PsycINFO, Web of Science, SPORTDiscus) were searched to systematically evaluate the literature regarding the association between body measures (i.e., anthropometric and body composition indicators) and body image in athletes. The systematic review was completed following PRISMA guidelines and 27 cross-sectional studies were identified for inclusion and evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Results: Studies differed in methodological assessment of anthropometry or body composition (i.e., self-reported versus researcher-measured), methods for evaluating aspects of body image, geographic location, and sport type. Higher body mass index (BMI) or percent body fat (%BF) was significantly associated with greater body dissatisfaction in 16 of 22 studies (72.7%). Positive associations between body measures and aspects of negative body image were most consistently observed among studies that assessed BMI based on self-reported heights and weights, while significant associations between body composition measures (e.g., %BF, fat mass, fat-free mass) were less common. Four of seven studies assessing relationships between BMI and an aspect of positive body image reported significant inverse relationships, while three revealed insignificant associations. Discussion: Overall, higher BMI and body fat were associated with body dissatisfaction among athletes. Future studies are needed to confirm these findings within focused populations and utilizing body composition methods (e.g., bioelectrical impedance techniques). Systematic review registration: https://www.crd.york.ac.uk/prospero/, CRD42023446518.
Supporting physical activity adoption through recommender system technology: A pilot study
(Journal of Health Psychology, 2024-04-16) Agans, Jennifer P.; Ma, Fenglong; Schade, Serena; Sciamanna, Christopher
We tested the potential for recommender system technology to provide personalized physical activity (PA) suggestions for inactive young adults with high bodyweight. We developed a recommender system using data from the 2017 Behavioral Risk Factor Surveillance System and assessed interest in using the system among 47 young adults (mean age = 23.0 years; 63.4% female; 65.0% White; mean BMI = 29.4). Eleven of these participants (mean age = 23.6 years; 90.9% female, 63.6% White; average BMI = 28.5) also received a PA recommendation and a follow-up interview. Approximately half of the survey participants were willing to use the recommender system, and participants interested in the recommender system differed from those unwilling to try the system (e.g., more likely to be female, worse self-perceived health). Furthermore, eight of the 11 interviewees tried the PA recommended to them, but had mixed reviews of the system’s accuracy. Although our recommender system requires improvements, such systems have promise for supporting PA adoption.
A short-term, randomized, controlled, feasibility study of the effects of different vegetables on the gut microbiota and microRNA expression in infants
(Frontiers in Microbiomes, 2024-03-01) Ferro, Lynn E.; Bittinger, Kyle; Trudo, Sabrina P.; Beane, Kaleigh E.; Polson, Shawn W.; Kim, Jae Kyeom; Trabulsi, Jillian C.
The complementary diet influences the gastrointestinal (gut) microbiota composition and, in turn, host health and, potentially, microRNA (miRNA) expression. This study aimed to assess the feasibility of altering the gut microbial communities with short-term food introduction and to determine the effects of different vegetables on the gut microbiota and miRNA expression in infants. A total of 11 infants were randomized to one of the following intervention arms: control, broccoli, or carrot. The control group maintained the milk diet only, while the other groups consumed either a broccoli puree or a carrot puree on days 1–3 along with their milk diet (human milk or infant formula). Genomic DNA and total RNA were extracted from fecal samples to determine the microbiota composition and miRNA expression. Short-term feeding of both broccoli and carrots resulted in changes in the microbiota and miRNA expression. Compared to the control, a trend toward a decrease in Shannon index was observed in the carrot group on days 2 and 4. The carrot and broccoli groups differed by weighted UniFrac. Streptococcus was increased on day 4 in the carrot group compared to the control. The expression of two miRNAs (i.e., miR-217 and miR-590-5p) trended towards decrease in both the broccoli and carrot groups compared to the control, whereas increases in eight and two different miRNAs were observed in the carrot and broccoli groups, respectively. Vegetable interventions differentially impacted the gut microbiota and miRNA expression, which may be a mechanism by which total vegetable intake and variety are associated with reduced disease risk.
Cardiac autonomic function is preserved in young adults with major depressive disorder
(American Journal of Physiology - Heart and Circulatory Physiology, 2024-03-01) Darling, Ashley M.; Dominguez, Cynthia M.; Skow, Rachel J.; Mogle, Jacqueline; Saunders, Erika F. H.; Fadel, Paul J.; Greaney, Jody L.
The prevalence of major depressive disorder (MDD) is highest in young adults and contributes to an increased risk of developing future cardiovascular disease (CVD). However, the underlying mechanisms remain unclear. The studies examining cardiac autonomic function that have included young unmedicated adults with MDD report equivocal findings, and few have considered the potential influence of disease severity or duration. We hypothesized that heart rate variability (HRV) and cardiac baroreflex sensitivity (BRS) would be reduced in young unmedicated adults with MDD (18–30 yr old) compared with healthy nondepressed young adults (HA). We further hypothesized that greater symptom severity would be related to poorer cardiac autonomic function in young adults with MDD. Heart rate and beat-to-beat blood pressure were continuously recorded during 10 min of supine rest to assess HRV and cardiac BRS in 28 HA (17 female, 22 ± 3 yr old) and 37 adults with MDD experiencing current symptoms of mild-to-moderate severity (unmedicated; 28 female, 20 ± 3 yr old). Neither HRV [root mean square of successive differences between normal heartbeats (RMSSD): 63 ± 34 HA vs. 79 ± 36 ms MDD; P = 0.14] nor cardiac BRS (overall gain, 21 ± 10 HA vs. 23 ± 7 ms/mmHg MDD; P = 0.59) were different between groups. In young adults with MDD, there was no association between current depressive symptom severity and either HRV (RMSSD, R2 = 0.004, P = 0.73) or cardiac BRS (overall gain, R2 = 0.02, P = 0.85). Taken together, these data suggest that cardiac autonomic dysfunction may not contribute to elevated cardiovascular risk factor profiles in young unmedicated adults with MDD of mild-to-moderate severity. NEW & NOTEWORTHY This study investigated cardiac autonomic function in young unmedicated adults with major depressive disorder (MDD). The results demonstrated that both heart rate variability and cardiac baroreflex sensitivity were preserved in young unmedicated adults with MDD compared with healthy nondepressed young adults. Furthermore, in young adults with MDD, current depressive symptom severity was not associated with any indices of cardiac autonomic function.
Cancer and the family: Variations by sex and race/ethnicity
(Cancer Medicine, 2024-02-01) Asiedu, Charlotte; McKinney, Nicole S.; Willis, Alliric I.; Lewis, Frances M.; Virtue, Shannon; Davey, Adam
Background Cancer affects patients and their families, but few data are available on factors associated with diversity of family structures among patients with cancer. Family is a source of both support and responsibility that must be understood to support patients and their families. Methods Pooled data (2004–2015) from the National Health Interview Study were used to compare characteristics of cancer survivors with and without minor children and differences by sex and race/ethnicity among survivors with minor children. Results 13.9% of cancer survivors have minor children in the household, and this experience is more likely for women and people who identify as other than non-Hispanic White. Conclusion There are considerable differences by sex and race/ethnicity in the characteristics of cancer survivors with minor children. Clinicians should make consideration of family circumstances a routine part of their history. Doing so will help to identify potential sources of support and responsibility that may affect adherence.
Sleep Variability, Eating Timing Variability, and Carotid Intima‐Media Thickness in Early Adulthood
(Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease, 2023-10-03) Hoopes, Elissa K.; Witman, Melissa A.; D'Agata, Michele N.; Brewer, Benjamin; Edwards, David G.; Robson, Shannon M.; Malone, Susan K.; Keiser, Thomas; Patterson, Freda
Background Day‐to‐day variability in sleep patterns and eating timing may disrupt circadian rhythms and has been linked with various adverse cardiometabolic outcomes. However, the extent to which variability in sleep patterns and eating timing relate to atherosclerotic development in subclinical stages remains unclear. Methods and Results Generally healthy adults (N=62, 29.3±7.3 years, 66% female) completed 14 days of sleep and dietary assessments via wrist accelerometry and photo‐assisted diet records, respectively. Variability in sleep duration, sleep onset, eating onset (time of first caloric consumption), eating offset (time of last caloric consumption), and caloric midpoint (time at which 50% of total daily calories are consumed) were operationalized as the SD across 14 days for each variable. Separate regression models evaluated the cross‐sectional associations between sleep and eating variability metrics with end‐diastolic carotid intima‐media thickness (CIMT) measured via ultrasonography. Models adjusted for age, sex, systolic blood pressure, sleep duration, and total energy intake. Each 60‐minute increase in sleep duration SD and sleep onset SD were associated with a 0.049±0.016 mm (P=0.003) and 0.048±0.017 mm (P=0.007) greater CIMT, respectively. Variability in eating onset and offset were not associated with CIMT; however, each 60‐minute increase in caloric midpoint SD was associated with a 0.033±0.015 mm greater CIMT (P=0.029). Exploratory post hoc analyses suggested that sleep duration SD and sleep onset SD were stronger correlates of CIMT than caloric midpoint SD. Conclusions Variability in sleep patterns and eating timing are positively associated with clinically relevant increases in CIMT, a biomarker of subclinical atherosclerosis, in early adulthood.
The relationship between cannabis and anorexia nervosa: a scoping review
(Journal of Eating Disorders, 2023-10-19) Rogers, Chloe I.; Pacanowski, Carly R.
Background Relapse rates in Anorexia Nervosa (AN) remain high, warranting exploration of further treatments. Cannabinoid agonists are of interest as they have shown successful outcomes in the treatment of associated conditions, such as post-traumatic stress disorder. This scoping review explores the endocannabinoid system (ECS), benefits/harms/null effects of cannabinoid treatment, and harms of cannabis use in AN. Methods PubMed, PsycINFO, Cochrane, and Web of Science were searched for studies published between 2010 and August 2023, with human participants that explored the ECS, cannabinoid treatment, or cannabis use, and included 1 or more keywords for both cannabis and AN in the title and or abstract. Reports describing secondary anorexia, reports not available in English, grey literature, reports combining data from AN with other conditions, and reports only reporting the prevalence of cannabis abuse/dependence were excluded. Data were extracted from 17 reports (n = 15 studies). For the ECS, outcomes included genetics such as allele expression related to the ECS, cannabinoid receptor availability, and circulating levels of endocannabinoids. For benefits/harms/null effects of cannabinoid treatment, outcomes included changes in weight, eating disorder (ED) symptoms, physical activity (PA), and hormones. For harms of cannabis use, outcomes included genetics related to cannabis use disorder and associations between cannabis use and ED symptoms. Results Eight studies (n = 8 reports) found abnormalities in the ECS in AN including expression of related alleles, genotypes, and haplotypes, availability of cannabinoid receptors, and levels of endocannabinoids. Three studies (n = 5 reports) found benefits/harms/null effects of cannabinoid treatment. Benefits included weight gain, improved ED symptoms and reduced PA, while null effects included no changes in weight or ED symptoms, and harms included increased PA and lowered adipose hormones. Four studies (n = 4 reports) expanded upon harms of cannabis use, including genetic predispositions to cannabis use disorder, and compensatory behaviors related to cannabis use. Conclusion Limited evidence suggests that abnormalities in the ECS in AN may render cannabis a potential treatment for weight restoration and associated symptoms. Future research may wish to investigate individualized dosing approaches to maximize beneficial effects while minimizing harms. Level II Evidence: Scoping Review.
Frailty in community-dwelling older people and nursing home residents: An adaptation and validation study
(Journal of Advanced Nursing, 2023-10-12) Kmetec, Sergej; Fekonja, Zvonka; Davey, Adam; Kegl, Barbara; Mori, Jernej; Reljić, Nataša Mlinar; McCormack, Brendan; Lorber, Mateja
Aim The aim of this was to psychometrically adapt and evaluate the Tilburg Frailty Indicator to assess frailty among older people living in Slovenia's community and nursing home settings. Design A cross-cultural adaptation and validation of instruments throughout the cross-sectional study. Methods Older people living in the community and nursing homes throughout Slovenia were recruited between March and August 2021. Among 831 participants were 330 people living in nursing homes and 501 people living in the community, and all were older than 65 years. Results All items were translated into the Slovene language, and a slight cultural adjustment was made to improve the clarity of the meaning of all items. The average scale validity index of the scale was rated as good, which indicates satisfactory content validity. Cronbach's α was acceptable for the total items and subitems. Conclusions The Slovenian questionnaire version demonstrated adequate internal consistency, reliability, and construct and criterion validity. The questionnaire is suitable for investigating frailty in nursing homes, community dwelling and other settings where older people live. Impact The Slovenian questionnaire version can be used to measure and evaluate frailty among older adults. We have found that careful translation and adaptation processes have maintained the instrument's strong reliability and validity for use in a new cultural context. The instrument can foster international collaboration to identify and manage frailty among older people in nursing homes and community-dwelling homes. Reporting Method The Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting cross-sectional studies was used. No Patient or Public Contribution No patient or public involvement in the design or conduct of the study. Head nurses from nursing homes and community nurses helped recruit older adults. Older adults only contributed to the data collection and were collected from nursing homes and community dwelling.
Feasibility, Acceptability, and Preliminary Effectiveness of a Sleep Intervention in Adults at Risk for Metabolic Syndrome With Short Sleep Duration
(Nursing Research, 2024-01) Malone, Susan Kohl; Patterson, Freda; Grunin, Laura; Yu, Gary; Dickson, Victoria Vaughan; Melkus, Gail D’Eramo
Background The prevalence of short sleep duration is rising and is linked to chronic comorbidities, such as metabolic syndrome (MetS). Sleep extension interventions in adults with MetS comorbidities and short sleep duration are limited and vary widely in terms of approach and duration. Objectives This pilot study aimed to test the feasibility and acceptability of a personalized 12-week systematic sleep time extension intervention on post-intervention sleep outcomes in middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration. Methods A single-arm, 12-week, 12-session systematic sleep time extension intervention was delivered weekly via videoconferencing. Feasibility and acceptability were assessed using retention rates and mean sleep diary completions. Sleep was estimated for 14 consecutive days prior to and immediately following the 12-week intervention using wrist actigraphy. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t-tests modeled changes in study outcomes. Results Study participants (N = 41) had a mean age of 52 years and were mostly female and White; 86% attended >80% of sessions, and mean sleep diary completion was 6.7 diaries/week. Significant improvements in sleep from pre- to post-intervention included increased total sleep time, earlier sleep onsets, more regular sleep onsets, a higher sleep regularity index, and reduced daytime sleepiness. Extending sleep, as well as improving sleep timing and regularity in middle-aged adults with actigraphy-estimated short sleep duration and at risk for MetS, is feasible and acceptable. Discussion Behavioral sleep characteristics may be modifiable and present a novel behavioral paradigm for mitigating MetS risk. This pilot study provides a proof of concept for the feasibility, acceptability, and preliminary effectiveness of a systematic sleep time extension for middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration.
School nurses: Researcher and clinician collaborations to address paediatric health inequities
(Journal of Advanced Nursing, 2023-08-02) Covington, Lauren B.; Hildick, Heidi; Robinson, Anastasia; Pennington, Mandy; Mansi, Suzanne; Ji, Xiaopeng; Strang, Abigail; Rani, Seema; Robson, Shannon; Lobo, Michele A.; Cuffee, Yendelela; Selekman, Janice; Taherzadeh, Sanaz; Carroll, Jill; Covey, Ann; Murray, Kenna; Zimmerman, Chriss; Horney, Jennifer A.; Sowinski, Christine; Patterson, Freda
School nurses are front-line paediatric public health providers who are eager and poised to address paediatric health inequities. They are tasked with remaining informed about current health issues (i.e. immunization updates, surges in emerging and reemerging illnesses, novel medications and side effects, etc.), but also the disparities that arise within different populations of students (Willgerodt et al., 2018). Further, school nurses are well-positioned to be advocates for the most vulnerable students at risk for health disparities and inequities. For example, school nurses are able to identify and advocate for students who experience food and housing insecurity, lack access to medical or dental care, and/or those who live in unstable or insecure environments (Gratz et al., 2021). School nurses bridge gaps that address lack of healthcare access for their students by making referrals to social workers, public health departments or statewide agencies. School nurses are truly community engaged—sharing with community members the top issues plaguing their students, as well as listening to and addressing priority health issues afflicting the community (Gratz et al., 2021; Willgerodt et al., 2018).
Snack frequency, size, and energy density are associated with diet quality among US adolescents
(Public Health Nutrition, 2023-08-07) Tripicchio, Gina L.; Bailey, Regan L.; Davey, Adam; Croce, Christina M.; Fisher, Jennifer Orlet
Objective: To evaluate snacking and diet quality among US adolescents. Design: Cross-sectional analysis examined snack frequency (snacks/day), size (kcal/snack) and energy density (kcal/g/snack) as predictors of diet quality using the mean of two 24-h dietary recalls. Diet quality was assessed using the Healthy Eating Index (HEI-2015, 0–100), a mean adequacy ratio (MAR, 0–100) for under-consumed nutrients (potassium, fibre, Ca, vitamin D) and mean percentage of recommended limits for over-consumed nutrients (added sugar, saturated fat, Na). Linear regression models examined total snacks, food only snacks and beverage only snacks, as predictors of diet quality adjusting for demographic characteristics and estimated energy reporting accuracy. Setting: 2007–2018 National Health and Nutrition Examination Survey. Participants: Adolescents 12–19 years (n 4985). Results: Snack frequency was associated with higher HEI-2015 (β = 0·7 (0·3), P < 0·05) but also with higher intake of over-consumed nutrients (β = 3·0 (0·8), P ≤ 0·001). Snack size was associated with lower HEI (β = –0·005 (0·001), P ≤ 0·001) and MAR (β = –0·005 (0·002), P < 0·05) and higher intake of over-consumed nutrients (β = 0·03 (0·005), P ≤ 0·001). Associations differed for food only and beverage only snacks. Food only snack frequency was associated with higher HEI-2015 (β = 1·7 (0·03), P ≤ 0·001), while food only snack size (β = –0·006 (0·0009), P ≤ 0·001) and food only snack energy density (β = –1·1 (0·2), P ≤ 0·001) were associated with lower HEI-2015. Conversely, beverage only snack frequency (β = 4·4 (2·1) P < 0·05) and beverage only snack size (β = 0·03 (0·01), P ≤ 0·001) were associated with higher intake of over-consumed nutrients. Conclusions: Smaller, frequent, less energy-dense food only snacks are associated with higher diet quality in adolescents; beverages consumed as snacks are associated with greater intake of over-consumed nutrients.
Diabetes Related Distress and Co-Occurrence with Depressive Symptoms in Urban Low-Income African American and Hispanic/Latinx Adults with Type 2 Diabetes
(Journal of Health Disparities Research and Practice, 2023) Ruggiero, Laurie; Leng, Sarah Williams; de Groot, Mary; Gerber, Ben S.; Hernandez, Rosalba; Quinn, Lauretta
Introduction. Burden of diabetes in the U.S. is greater in racial-ethnic minority populations than non-Hispanic Whites. Depression and diabetes-related distress (DRD) are recognized as relatively common and important psychosocial areas to address in people living with diabetes. Limited research in the U.S. has focused on DRD in racial-ethnic minority populations. The purpose of this study is to describe patterns of DRD and co-occurrence with depressive symptoms in urban low-income African American and Hispanic/Latinx adults with type 2 Diabetes Mellitus (T2DM). Method. We examined the baseline data collected for a randomized clinical trial (RCT) studying the impact of a culturally tailored diabetes self-care intervention. Individuals with T2DM who self-identified as African American or Hispanic/Latinx were recruited from Federally Qualified Health Centers (FQHCs). Measurement scales included the Patient Health Questionnaire (PHQ-9) and Diabetes Distress Scale (DDS). Participants were categorized into four groups based on the PHQ-9 and DDS: high distress (without probable clinical depression), probable clinical depression (without high distress), both high distress and probable depression, or neither high distress nor probable depression. Baseline variables were summarized by sex, age and racial-ethnic group. Analyses included independent sample t-tests, Chi-square tests, and one-way Analysis of Variance (ANOVA). Results. The study sample included 247 participants with 118 (47.8%) Hispanic/Latinx and 129 (52.2%) African American adults with T2DM. The mean age was 52.9 years (SD=12.2) and 68.0% were female. Based on PHQ-9 scores, 51.4% had none to minimal, 23.5% mild, and 25.1% moderate-severe depressive symptomatology. Based on the DDS, 37.7% had little to no DRD, 27.1% moderate, and 35.2% high DRD. There was not a statistically significant relationship between sex and depression or DRD levels. There was not a statistically significant difference between age and depression; however, there was a statistically significant difference between age and DRD (p=.002). When examining the co-occurrence of DRD and depression, over half of the participants did not experience high distress nor probable clinical depression (57.5%), 17.8% experienced both high distress and depression, 17.4% experienced high distress without depression, and 7.3% experienced depression without distress. There was no statistically significant relationship found between sex and co-occurrence groups; however, there was a statistically significant difference for age (p=.003). Discussion. A substantial proportion of individuals from both racial-ethnic groups experienced high DRD and/or probable clinical depression with some differences for age. Patterns found for specific DRD areas and co-occurrence of DRD and depressive symptoms can help clinicians better understand and address these challenges.
A Reflection on the Relationship Between Place and Health: Understanding Undergraduate Student Experiences and Priorities During the COVID-19 Pandemic
(Delaware Journal of Public Health, 2022-08) Rao, Abhigna; Hoffman, Lindsay; Bleakley, Amy; Karpyn, Allison
Environment and setting have a large influence on matters of population health, and college is a critical place for students, shaping both health and education. College students across the nation were impacted by the COVID-19 pandemic, and changes at universities left many anxious, isolated, and coping with social, emotional, and educational impacts. Objective: To perform a data analysis of the qualitative responses garnered through the Student Return to Campus Survey administered at the University of Delaware (UD) in Spring 2020, and to identify common themes of student experiences and priorities during the pandemic years to inform future recommendations for health crisis management. Methods: The study utilized secondary data analysis from an online student experience survey of 2,941 Freshman, Sophomore, and Junior students from the 2020-2021 academic year. Results: Qualitative analysis revealed a set of common outstanding themes influencing the college pandemic experience, including: Quality and Accessibility of Education in a Virtual Learning Environment; Quality of Student Life; Mental Health During the Pandemic; Thoughts and Attitudes About Vaccination Policies, Masking, Testing, and COVID Guidelines; Priorities and Considerations About the Return to Campus; and Overall Feelings About the Pandemic at UD. Conclusions: Student experiences were influenced by academic, social, emotional, and financial factors, which were often described with great intensity, and were at times contradictory. Students emphasized struggles with transitioning to and with virtual learning, the quality of campus resources, financial responsibilities, family health, and personal health. The results also shed light on the importance of communication with the campus community and the desire for students to express opinions during a crisis. Health Policy Implications: The results of this study have implications for crisis management for college campuses and planning for future responses to unanticipated events and ongoing COVID-19 mitigation efforts.
Exploration of Sex and Age as Moderators Between Social Cumulative Risk and Sleep in a Representative Sample of Children and Adolescents Living in the United States
(International Journal of Behavioral Medicine, 2023-04-25) Covington, Lauren B.; Ji, Xiaopeng; Laurenceau, Jean-Philippe; Patterson, Freda; Brownlow, Janeese A.
Background Youth who face adversity are at a disproportionate risk for poor sleep health across the life course. Identifying whether the association between adversity and poor sleep varies based upon age and sex is needed. This study aims to explore sex and age as moderators between social risk and sleep in a sample of U.S. youth. Methods This study analyzed data of 32,212 U.S. youth (6–17 years) whose primary caregiver participated in the 2017–2018 National Survey of Children’s Health. A social cumulative risk index (SCRI) score was calculated from 10 parental, family, and community risk indicators. Nighttime sleep duration was the number of hours the child slept during the past week. Weeknight sleep irregularity was operationalized as whether the child sometimes/rarely/never went to bed at the same time. Generalized logistic regression models estimated associations between SCRI and sleep duration/irregularity, with age and sex as moderators. Results Age moderated the association between SCRI and short sleep (OR = 1.12, p < 0.001), such that the magnitude of the SCRI-sleep relationship was 12% greater in school-age children. Sex was not a significant moderator. In stratified models by age group, age was positively associated with short sleep in both groups, with a greater magnitude in school-age children. Female school-age children were less likely to have short sleep than males. Conclusions Younger children with greater social cumulative risk factors may be more vulnerable to short sleep duration. Further research into the mechanisms underlying the relationships between social risk and sleep health in school-age children is needed.

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